Pathology/Lab Coding Alert

Deleted 0357T leads to unlisted code.

Among CPT^® changes that lab coders might fail to notice, put Category III codes at the top of the list. But you can’t afford to miss changes to this section that might impact how you report procedures, even if it is buried in the back of the code book.

Let our experts help you understand Category III codes, and which 2020 changes you should heed.

Recognize Code Hierarchy

Whether you call them “T-codes” or Category III codes, you need to know the purpose and placement of this unique grouping that includes some lab test procedures.

Purpose: These are temporary codes, primarily intended to allow collection of specific data that using an “unlisted” code does not allow. The CPT^® guidelines for the Category III section states that the codes provide an opportunity for stakeholders “to identify emerging technology, services, procedures, and service paradigms for clinical efficacy, utilization, and outcomes.”

“The need for these codes [arose] due to the development of new technology,” says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the Hospital of the University of Pennsylvania.

Priority: Because the purpose is data collection, CPT^® guidelines indicate that if a Category III code is available for a service, you must use that code instead of an unlisted Category I code.

From a billing standpoint, keep in mind that Category III codes often apply to services that payers consider investigational/experimental. “It may be a while before this service is rendered effective and covered,” Pohlig says.

Check expiration: Remember that Category III codes have an expiration date, typically after five years. CPT^® either converts the procedure to a Category I code before that date or archives the code at the deadline due to limited use. “If you use any Category III codes, you need to check every year to ensure that each code is still valid,” says Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, national director of marketing and revenue management at FasPsych in Omaha, Nebr.

Do this: If a Category III code that you use has been deleted, you need to learn if it has been replaced with a new Category I code that you should use instead.

Greet 0564T

CPT^® 2020 adds 0564T (Oncology, chemotherapeutic drug cytotoxicity assay of cancer stem cells (CSCs), from cultured CSCs and primary tumor cells, categorical drug response reported based on percent of cytotoxicity observed, a minimum of 14 drugs or drug combinations) to the Category III code section.

Background: Certain cancer cells that can self-renew, called cancer stem cells (CSC) or tumor initiating cells (TIC), evidently impact resistance to chemotherapeutic agents and subsequent cancer relapse. CSCs appear to influence recurrence of many types of cancer.

The 0564T test uses patient primary tumor cells and CSCs from patient tumor cell culture to evaluate chemo-sensitivity and cytotoxicity of at least 14 chemotherapy drugs or combination of drugs.

Clinical value: Initial selection of the best chemotherapy drug(s) for the patient’s particular cancer can increase effectiveness as early as possible in treatment; and avoid trial and error with drugs that can lead to toxicity, delay in effective treatment, and the opportunity for development of resistant clones.

The test is now identified as ChemoID^®, which is a CLIA-certified, CAP-accredited laboratory-developed test, and was developed to allow identification of the most effective drug(s) for the specific patient before beginning chemotherapy, according to a news release from Edwards Comprehensive Cancer Center (ECC) where much of the research for the test was conducted.

“This process allows the drugs to be used on the cancer cells and not the patient. It can lead to faster and more dramatic positive results,” explained Anthony M. Alberico, MD, FACS, neurosurgeon and medical director of the Cabell Huntington Hospital Back and Spine Center and professor and chair of the Department of Neurosurgery at the Marshall University Joan C. Edwards School of Medicine in the news release.

Say Goodbye to 0357T

One lab code from the Category III section expired for CPT^® 2020, with no new Category I code appearing in its place. That code is 0357T (Cryopreservation; immature oocyte(s)). New instruction directs you to use the unlisted code 89398 (Unlisted reproductive medicine laboratory procedure) for this procedure beginning Jan. 1.

For cryopreservation of mature oocytes, turn to 89337 (Cryopreservation, mature oocyte(s)) according to the new text note in the Category III section.